Professional perceptions of psychiatric advance directives : a view of multiple stakeholders in Ontario and Québec

Psychiatric advance directives (PADs) are legal documents allowing competent individuals to declare their treatment preferences in advance of a mental health crisis. The objective of this thesis is to examine psychosocial perceptions of legal and mental health professionals in Ontario and Quebec regarding their knowledge and willingness to implement PADs. Two hundred professionals---psychiatrists, psychologists, lawyers and administrative tribunal members---participated in an Web-survey measuring psychosocial perceptions of clinical, ethical, legal and implementation factors of PADs. Results indicate Quebec professionals are more willing to begin using PADs than Ontario professionals. Mental health professionals reported more concern than legal professionals for medical malpractice lawsuits for overriding PADs. Advantages of PADs most commonly reported are patients' ability to declare their clear wishes ahead of time, respect for autonomous choice, and establishing a collaborative treatment plan with physicians. Disadvantages included patients' lack of awareness, treatment refusal, and being self-bound to an earlier decision